Fendley, Jack T
Fendley, Jack T is an individual health care provider with primary practice located at 3500 Springhill Dr Ste 100 , North Little Rock AR 72117-2949. He recently has 5 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Adult Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine, Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Fendley, Jack T can be contacted via phone (501) 955-5589.Contact Information
Primary practice address
3500 Springhill Dr Ste 100
North Little Rock AR 72117-2949
Phone: (501) 955-5589
Fax: (501) 955-5960
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | C4596 | Arkansas |
| Allopathic & Osteopathic Physicians / Adult Medicine | 207QA0505X | C4596 | Arkansas |
| Allopathic & Osteopathic Physicians / Geriatric Medicine | 207QG0300X | C4596 | Arkansas |
| Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism | 207RE0101X | C4596 | Arkansas |
| Allopathic & Osteopathic Physicians / Geriatric Medicine | 207RG0300X | C4596 | Arkansas |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | C4596 | Arkansas |
Profile Details
| NPI number | 1821074592 |
|---|---|
| LBN Legal business name | Fendley, Jack T |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 15th, 2005 |
| Last updated | Mar 23rd, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1821074592 | NPPES |
| Arkansas | Other | 0420289 | UNITED HEALTHCARE ID |
| Arkansas | Other | 110190362 | UNITED HEALTHCARE ID |
| Arkansas | Other | 11306000000 | UNITED HEALTHCARE ID |
| Arkansas | MEDICAID | 106701001 | UNITED HEALTHCARE ID |
| Arkansas | Other | 4234056 | UNITED HEALTHCARE ID |
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